Typical Therapeutic Interventions
Intervention will vary according to the needs of the individual but should always focus on: reducing anxiety and increasing confidence with communication and interaction. The focus should not be on getting the child to "talk". By removing the pressure to speak the indivudal will be more able to move through the stage of noverbal communication to speaking confidence. Interventions may include a combination of:
For parents, schools (teachers and students), social groups. These can be accessed through local advocacy groups if they are available in your area or produced and presented by the team around the child. See the resources section for advice on resources that can be used to support these sessions. The most important message to get across in these training is that the child is experiencing real FEAR and not being stubborn or defiant. All adults and children involved can then works towards helping the child feel that it is ok not to speak to help first increase their confidence in interaction. Trainings are best when individualised according to the child's needs.
This is often a key factor in any SM programme and involves gradual desensitisation to social and/or speaking activities and is coined "sliding-in" in The Selective Mutism Resource Manual. It involves using small steps to help the child overcoming the fear of speaking and is similar to the process of gradually learning to sleep with the light off e.g. start with light fully on and work towards the light on in the hallway with the door gradually closing. Another behavioural option may involve shaping whereby the child gradually begins to move from use of non-verbal communication to speech with incremental steps. Both options are complimented through the use of positive reinforcement to help develop the child's motivation to make progress and develop self esteem and confidence.
Changes in the style of adult interaction with the child with SM are often vital in ensuring that any factors that maintain the mutism are removed. Assessments such as the Environmental Checklists from the SMIRA website (see link in the resources section) will help to identify which maintaining factors are present and thus help to plan to remove them. Often strategies such as removing any pressure to speak; doing things with rather than for the child will be advocated and it is common that parenting styles and interactions may need to be altered. Environmental changes and strategies for school should be collaboratively developed and included on the child's Individual Education Plan
Therapy in Your Everyday Activities
Using strategies through play with both adults and children can help to increase the child's confidence and practice the use of strategies. There are many different options available e.g. school peer groups involving co-operative interactions; home play sessions practicing removing pressures to speak. These differ from play therapy sessions that take a more psychoanalytic or counselling slant however, these too are reported in the literature.
The book "Supporting Quiet Children" written by Michael Jones and Maggie Johnson is fantastic resource that gives pages of easy to follow suggestions for games, activities and strategies to support children with Selective Mutism and reluctant speakers in and out of the classroom. The book shares ideas for developing confidence and comfort in play without any pressure to speak. The activities are great for individual or group sessions and there will be something in there to suit every shy or quiet child. The book can be purchased at this link from Lawrence Educational.
Speech and Language Therapy
If assessment shows that there are underlying language or social communication difficulties it is important that these are addressed as they may be contributing to speech anxiety. Therapy used will depend on the needs of the child. If the child is unable to speak to the therapist parents can practice activities at home with their child to ensure that they can still access this support. In the absence of speech, language and communication diffficulties the Speech Pathologist can play a large role in the behavioural interventions for SM due to their background training in communication skills. They can also be of support to provide and demonstrate visual aids for communication to help reduce the pressure on the child to communicate verbally and continue to develop language and literacy skills.
The Occupational Therapist will be able to support with clarifying any difficulties with daily tasks and/or fine motor skills and will play a large part in supporting with any difficulties with sensory regulation.
Cognitive Behavioural Therapy
This can take many forms however the most effective methods will enable the child to recognise: their anxiety and how it feels, the thoughts that can cause it and the resulting outcomes. Then supporting the individual to learn how to change their thoughts through use of strategies to enable positive outcomes that are peronsally motivating for them.
Medication is used in the treatment of SM however the long term effects are unknown. Medication would NEVER be advisable as the only treatment option or as the first step with treament. Medication should only be considered when all other options have not been effective and in such cases decisions should be made carefully with a doctor and psychologist to ensure that a fully informed decision can be made.